Delayed postoperative paralysis in adolescent idiopathic scoliosis: Management with partial removal of hardware and staged correction

A delayed spinal epidural hematoma following scoliosis surgery is relatively uncommon but well recognized by clinical and radiographic findings. A 12-year-old girl with scoliosis measuring 80° lower thoracic curve underwent anterior (T6-T12) and posterior fusion with posterior instrumentation from T2 to L1. She developed bilateral leg weakness and progressive left lower leg paralysis 24 hours later. Emergent decompression and partial removal of hardware was performed. Reinsertion of segmental instrumentation and correction of her curve was performed 2 weeks later. The patient had complete recovery of her neurologic deficits, and her correction was maintained at 85% at 4-months follow-up. The authors recognized that there should be no delay in returning the patient to surgery if neurological deficits are noticed. Exploration and decompression of "an occupying lesion" and release of cord tension by partial removal of hardware and reinstrument can achieve appropriate original correction of scoliosis and satisfactory clinical outcome.